Centre for Primary Health Care & Equity, University of New South Wales, Sydney, Australia.
J Interprof Care. 2011 Jul;25(4):258-64. doi: 10.3109/13561820.2011.566650. Epub 2011 May 9.
Ongoing care for chronic conditions is best provided by interprofessional teams. There are challenges in achieving this where teams cross organisational boundaries. This article explores the influence of organisational factors on collaboration between private and public sector primary and community health services involved in diabetes care. It involved a case study using qualitative methods. Forty-five participants from 20 organisations were purposively recruited. Data were collected through semi-structured interviews and from content analysis of documents. Thematic analysis was used employing a two-level coding system and cross case comparisons. The patterns of collaborative patient care were influenced by a combination of factors relating to the benefits and costs of collaboration and the influence of support mechanisms. Benefits lay in achieving common or complementary health or organisational goals. Costs were incurred in bridging differences in organisational size, structure, complexity and culture. Collaboration was easier between private sector organisations than between private and public sectors. Financial incentives were not sufficient to overcome organisational barriers. To achieve more coordinated primary and community health care structural changes are also needed to better align funding mechanisms, priorities and accountabilities of the different organisations.
慢性病的持续护理最好由多专业团队提供。在团队跨越组织边界的情况下，实现这一目标存在挑战。本文探讨了组织因素对参与糖尿病护理的私营和公营部门初级和社区卫生服务之间合作的影响。这是一项使用定性方法的案例研究。从 20 个组织中有意招募了 45 名参与者。通过半结构化访谈和文件内容分析收集数据。采用两级编码系统和跨案例比较进行主题分析。协作患者护理的模式受到与合作的收益和成本以及支持机制影响相关的因素的组合的影响。收益在于实现共同或互补的健康或组织目标。成本是在弥合组织规模、结构、复杂性和文化差异时产生的。私营部门组织之间的合作比私营部门和公共部门之间的合作更容易。财务激励措施不足以克服组织障碍。为了实现更协调的初级和社区卫生保健，还需要进行结构性变革，以更好地调整不同组织的资金机制、优先事项和问责制。
